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Controlling fever in children

More than almost any other common condition, fever causes great worry in parents. They look at their red-cheeked child and wonder if the fever itself can somehow harm their child or if it’s a sign that a more serious illness is present. Indeed, the majority of the calls to our practice are related to fevers in children.

One common myth is that the higher the fever, the worse the illness.

Of course, even knowing this, parents often wish to give their children some type of medication to lower the fever and make the child more comfortable, which is very understandable. So by and large, when we recommend the use of these medications, it is as a comfort measure. Parents often ask if they should wake their child to give them the medicine. We feel that letting the child sleep is the best thing to do and then give the medication when she or he wakes up. That also might be a good time to offer a drink of clear liquids like water to make sure the child stays well hydrated.

When to call the doctor
Any infant age three months or younger with a fever is immediately brought in for an exam. After that, the data is less absolute. The American Academy of Pediatrics recommends parents call their pediatrician within 24 hours for fever in children a year old or less. You should also call if other symptoms—such as neck pain, vomiting or diarrhea—are present.

Deciding which medication to use
As for which medication to give, we recommend parents try Tylenol^® first. If the fever does not go down after 30 to 45 minutes, we will then recommend giving the appropriate dose of ibuprofen on top of that. Then, parents should stick with the single medication that worked best. We don’t suggest they switch back and forth.

To avoid overdosing, parents should write down when medication was given, especially for those doses given in the middle of the night or if there is more than one sick child in the house. You want to avoid giving too much medication, which can be very dangerous. When it comes to a child’s medication, more is not better.

We suggest using Tylenol (acetaminophen) first because, when taken properly, it’s one of the safest medications available. Sadly, though, acetaminophen poisoning can and does happen and can lead to liver failure. It’s a leading reason why children undergo liver transplants.

Confusing packaging, dosage information
Parents should know that these medications come in different strengths. Infant drops are extremely concentrated, so use less. Always use the measuring device that comes with the medication. If it came with a dropper, use the dropper. If it comes with a cup, use only the cup. Be very cautious about using cold medications, which often also contain either acetaminophen or ibuprofen. We usually don’t recommend these combination medications because, for one thing, the cold products don’t work in children younger than two years old. And there’s the potential for overdosing. So read labels very carefully.

To help with dosing information, our practice includes a simple dosing chart in the baby books we give out. It’s also reasonable to call your local pharmacist for simple dosage questions.

Dr. Germain is a pediatrician on the attending staff of Yale-New Haven Children’s Hospital and an assistant clinical professor of pediatrics at Yale University School of Medicine.